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Desensitizations for Chemotherapy and Monoclonal Antibodies: Indications and Outcomes

  • ANAPHYLAXIS AND DRUG ALLERGY (DA KHAN AND M CASTELLS, SECTION EDITORS)
  • Published:
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Abstract

Acute infusion reactions to both chemotherapeutic agents and humanized monoclonal antibodies can occur, which may limit therapeutic options for treatment of malignancies and chronic inflammatory diseases. Many of these acute infusion reactions are consistent with a type I hypersensitivity reaction, including anaphylaxis. If a patient experiences a significant acute infusion reaction, often the recommendation is to discontinue the medication and find an alternative agent. However, the “second-line” agent may be more toxic or inferior. If the reaction is likely a type I or type IV hypersensitivity reaction, one option is to undergo desensitization to the offending drug. Drug desensitization is the process of readministering a needed drug in incremental doses over hours or days until a full therapeutic dose is tolerated. This article will review the current literature on indications and outcomes for drug desensitization in the management of allergy to either chemotherapeutic agents or monoclonal antibodies.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Castells MC, Tennant NM, Sloane DE. Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 413 cases. J Allergy Clin Immunol. 2008;122:574–80.

    Article  CAS  PubMed  Google Scholar 

  2. Markman M, Kennedy A, Webster K, Elson P, Peterson G, Kulp B, et al. Clinical features of hypersensitivity reactions to carboplatin. J Clin Oncol. 1999;17:1141–5.

    CAS  PubMed  Google Scholar 

  3. Markman M, Kennedy A, Webster K, Kulp B, Peterson G, Belinson J. Paclitaxel-associated hypersensitivity reactions: experience of the gynecologic oncology program of the Cleveland Clinic Cancer Center. J Clin Oncol. 2000;18:102–5.

    CAS  PubMed  Google Scholar 

  4. Chung CH, O’Neil BH. Infusion reactions to monoclonal antibodies for solid tumors: immunologic mechanisms and risk factors. Oncology. 2009;23:14–7.

    PubMed  Google Scholar 

  5. Moon DH, Lee JM, Noonan AM, Annunziata CM, Minasian L, Houston N, et al. Deleterious BRCA1/2 mutation is an independent risk factor for carboplatin hypersensitivity reactions. Br J of Cancer. 2013;109:1072–8. This article identified BRCA1/2 mutation carriers to be higher risk for platinum agent hypersensitivity.

    Article  CAS  Google Scholar 

  6. Cernadas JR, Brockow K, Romano A, et al. General considerations on rapid desensitization for drug hypersensitivity: a consensus statement. Allergy. 2010;65:1357–66.

    Article  CAS  PubMed  Google Scholar 

  7. Pyle RC, Butterfield JH, Volcheck GW, Podjasek JC, Rank MA, Li JT, et al. Successful outpatient graded administration of trimethoprim-sulfamethoxazole in patients without HIV and a history of sulfonamide adverse drug reaction. J Allergy Clin Immunol Pract. 2014;2:52–8.

    Article  PubMed  Google Scholar 

  8. Iwamoto T, Yuta A, Tabata T, et al. Evaluation of basophil CD203c as a predictor of carboplatin-related hypersensitivity reaction in patients with gynecologic cancer. Biol Pharm Bull. 2012;35(9):1487–95. This article suggests that basophil activation test may help predict carboplatin-related anaphylaxis.

    CAS  PubMed  Google Scholar 

  9. Wong JT, Ling M, Patil B, Banerji A, Long A. Oxaliplatin hypersensitivity: evaluation, implications of skin testing, and desensitization. J Allergy Clin Immunol Pract. 2014;2:40–5. The first large retrospective series of oxaliplatin hypersensitivity in 48 patients treated with 200 successful desensitizations.

    Article  PubMed  Google Scholar 

  10. Kim RJ, Peterson G, Kulp B, et al. Skin toxicity associated with pegylated liposomal doxorubicin (40 mg/m2) in the treatment of gynecologic cancers. Gynecol Oncol. 2005;97:374–8.

    Article  CAS  PubMed  Google Scholar 

  11. Lotem M, Lyass O, Goldenhersh MA, et al. Skin toxic effects of polyethylene glycol-coated liposomal doxorubicin. Arch Dermatol. 2000;136:1475–80.

    Article  CAS  PubMed  Google Scholar 

  12. Markman M, Zanotti K, Peterson G, Kulp B, Webster K, Belinson J. Expanded experience with an intradermal skin test to predict for the presence or absence of carboplatin hypersensitivity. J Clin Oncol. 2003;21:4611–4.

    Article  CAS  PubMed  Google Scholar 

  13. Gomez R, Harter P, Luck HJ, Traut A, Kommoss S, Kandel M, et al. Carboplatin hypersensitivity: does introduction of skin test and desensitization reliably predict and avoid the problem? A prospective single-center study. Int J Gynecol Cancer. 2009;19:1284–7.

    Article  PubMed  Google Scholar 

  14. Patil S, Long A, Ling M, et al. A protocol for risk stratification of patients with carboplatin-induced hypersensitivity reactions. J Allergy Clin Immunol. 2012;129:443–7.

    Article  CAS  PubMed  Google Scholar 

  15. Brennan PJ, Rodriguez Bouza T, Hsu F, et al. Hypersensitivity reactions to mAbs: 105 desensitizations in 23 patients, from evaluation to treatment. J Allergy Clin Immunol. 2009;124:1259–66.

    Article  CAS  PubMed  Google Scholar 

  16. Matucci A, Pratesi S, Petroni G, et al. Allerogological in vitro and in vivo evaluation of patients with hypersensitivity reactions to infliximab. Clin Exp Allergy. 2013;43:659–64.

    CAS  PubMed  Google Scholar 

  17. Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol. 2004;114:371–6.

    Article  PubMed  Google Scholar 

  18. Dizon DS, Sabbatini PJ, Aghajanian C, et al. Analysis of patients with epithelial ovarian cancer or fallopian tube carcinoma retreated with cisplatin after the development after a carboplatin allergy. Gynecol Oncol. 2002;84(3):378–82.

    Article  CAS  PubMed  Google Scholar 

  19. Syrigou E, Nektaria M, Vassias A, et al. Administration of cisplatin in three patients with carboplatin hypersensitivity: is skin testing useful? Anti-Cancer Drugs. 2010;21:333–8.

    Article  CAS  PubMed  Google Scholar 

  20. Hesterberg P, Banerji A, Oren E, et al. Risk stratification for desensitization of patients with carboplatin hypersensitivity: clinical presentation and management. J Allergy Clin Immunol. 2009;129:1262–7.

    Article  Google Scholar 

  21. Caiado J, Pereira-Santos MC VL, Costa L, Barbosa M, Castells M. Carboplatin, oxaliplatin and cisplatin-specific IgE: cross reactivity and value in the diagnosis of carboplatin and oxaliplatin allergy. J Allergy Clin Immunol: In Practice. 2013;1:494–500. Once validated, specific IgE may be useful in risk-stratifying patients.

    Article  Google Scholar 

  22. Madrigal-Burgaleta R, Berges-Gimeno MP, Angel-Pereira D, Ferreiro-Monteagudo R, Ruillen-Ponce C, Pueyo C, et al. Hypersensitivity and desensitization to antineoplastic agents: outcomes of 189 procedures with a new short protocol and novel diagnostic tools assessment. Allergy. 2013;68(7):853–61. A new shorter desensitization protocol.

    Article  CAS  PubMed  Google Scholar 

  23. Piva E, Chieco-Bianchi F, Krajcar V, et al. Adverse reactions in patients with B-cell lymphomas during combined treatment with rituximab: in vitro evaluation of rituximab hypersensitivity by basophil activation test. Am J Hematol. 2012;87(11):E130–1. This article also evaluates basophil activation test as a possible marker for predication of anaphylaxis.

    Article  CAS  PubMed  Google Scholar 

  24. Gastaminza G, de la Borbolla JM, Goikoetxea MJ, Escudero R, Anton J, Espinos J, et al. A new rapid desensitization protocol for chemotherapy agents. J Investig Allergol Clin Immunol. 2011;21(2):108–12. This article reviews a desensitization protocol that is shorter and a premedication regimen based on radiocontrast allergy.

    CAS  PubMed  Google Scholar 

  25. Chung CH, Mirakhur B, Chan E, et al. Cetuximab-induced anaphylaxis and IgE specific fort galactose-α-1,3-galactose. N Engl J Med. 2008;358:1009–17.

    Article  Google Scholar 

  26. Commins SP, James HR, Kelly LA, Pochan SL, Workman LJ, Perzanowski MS, et al. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose. J Allergy Clin Immunol. 2011;127(5):1286-–93.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Joint Task Force on Practice Parameters, American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. Drug Allergy. An updated practice parameter. Ann Allergy Asthma Immunol. 2010;105(4):259–73.

    Article  Google Scholar 

  28. Sakaeda T, Kadoyama K, Yabuuchi H, Niijima S, Seki K, Shiraishi Y, et al. Platinum agent-induced hypersensitivity reactions: data mining of the public version of the FDA Adverse Event Reporting System. AERS Int J Med Sci. 2011;8(4):332–8.

    Article  Google Scholar 

  29. Herrero T, Tornero P, Infante S, Fuentes V, Sanchez NM, de Barrio M, et al. Diagnosis and management of hypersensitivity reactions caused by oxaliplatin. J Investiga Allergol CLin Immunol. 2006;16(5):327–30.

    CAS  Google Scholar 

  30. Breslow RG, Caiado J, Castells MC. Acetylsalicyclic acid and montelukast block mast cell mediator-related symptoms during rapid desensitization. Ann Allergy Asthma Immunol. 2009;102:155–60.

    Article  CAS  PubMed  Google Scholar 

  31. Vultaggio A, Maggi E, Matucci A. Immediate adverse reactions to biologicals: from pathogenic mechanisms to prophylactic management. Curr Opin Allergy Clin Immunol. 2013;11:262–8.

    Article  Google Scholar 

  32. Ojaimi S, Harnett PR, Fulcher DA. Successful carboplatin desensitization by using omalizumab and paradoxical diminution of total IgE levels. J Allergy Clin Immunol Pract. 2014;2:105–6. This case report presents the added benefit of using omalizumab for drug desensitization.

    Article  PubMed  Google Scholar 

  33. Sancho-Serra Mdel C, Simarro M, Castells M. Rapid IgE desensitization is antigen specific and impairs early and late mast cell responses targeting FcepsilonRI internalization. Eur J Immunol. 2011;41:1004–13.

    Article  PubMed  Google Scholar 

  34. Morales AR, Shah N, Castells M. Antigen-IgE desensitization in signal transducer and activator of transcription 6-deficient mast cells by suboptimal doses of antigen. Ann Allergy Asthma Immunol. 2005;94:575–80.

    Article  CAS  PubMed  Google Scholar 

  35. Aydogan M, Yologlu N, Gacar G, et al. Successful rapid rituximab desensitization in an adolescent patient with nephrotic syndrome: increase in number of Treg cells after desensitization. J Allergy Clin Immunol. 2013;132(2):478–80. This case report also highlights increased in Treg cells after a successful desensitization.

    Article  PubMed  Google Scholar 

  36. Banerji A, Brennan P, Hesterberg P, et al. Drug desensitizations in the management of allergy and anaphylaxis to chemotherapeutic agents and monoclonal antibodies. In: Castells MC, editor. Anaphylaxis and Hypersensitivity Reactions. New York: Humana Press; 2011. p. 297–311.

    Chapter  Google Scholar 

  37. Prieto García A, de la Pineda Losa F. Immunoglobulin E-mediated severe anaphylaxis to paclitaxel. J Investig Allergol Clin Immunol. 2010;20(2):170–1.

    PubMed  Google Scholar 

  38. Castells MC, Matulonis UA. Infusion reactions to systemic chemotherapy. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA (Accessed on December 10, 2013)

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Compliance with Ethics Guidelines

Conflict of Interest

Karen Hsu Blatman declares that she has no conflict of interest.

Mariana Castells declares that she has received personal fees from Merck, Sanofi, UpToDate, and BWH; grants from NIH Desensitization; and nonfinancial support from AAAAI BOD.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 850 Boylston Street Suite 540, Chestnut Hill, MA, 02467, USA

    Karen S. Hsu Blatman

  2. Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 1 Jimmy Fund Way, Smith Building, Room 626D, Boston, MA, USA

    Mariana C. Castells

Authors
  1. Karen S. Hsu Blatman
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  2. Mariana C. Castells
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Correspondence to Karen S. Hsu Blatman.

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This article is part of the Topical Collection on Anaphylaxis and Drug Allergy

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Hsu Blatman, K.S., Castells, M.C. Desensitizations for Chemotherapy and Monoclonal Antibodies: Indications and Outcomes. Curr Allergy Asthma Rep 14, 453 (2014). https://doi.org/10.1007/s11882-014-0453-5

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  • DOI: https://doi.org/10.1007/s11882-014-0453-5

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